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Arterial hypertension and multiple cerebral aneurysms in a patient treated with electroconvulsive therapy
L J Drop1, A J Bouckoms, C A Welch
1Department of Anesthesia, Massachusetts General Hospital, Boston 02114.
Insights
This study details managing severe hypertension during electroconvulsive therapy (ECT) for drug-resistant depression in a patient with intracranial aneurysms. Timolol combined with sodium nitroprusside effectively controlled blood pressure during subsequent ECT sessions.
Area of Science:
- Neuroscience
- Cardiology
- Psychiatry
Background:
- Managing patients with major depression and comorbid cardiovascular conditions like arterial hypertension and intracranial aneurysms presents unique clinical challenges.
- Electroconvulsive therapy (ECT) is an effective treatment for severe, drug-resistant depression but requires careful hemodynamic monitoring and management.
Abstract:
The authors successfully instituted two courses of ECT at a 1-year interval for drug-resistant major depression in a patient with arterial hypertension and intracranial aneurysms. Both ECT courses required arterial and central venous cannulas, but the first course was complicated by an unusual and excessive degree of hypertension, which was not appropriately responsive to high doses of sodium nitroprusside (9 micrograms/kg/minute). Appropriate responsiveness to nitroprusside was established after therapy with timolol. The combination of sodium nitroprusside and timolol proved effective throughout the second course of ECT.